Spiral slit endotracheal tube

ABSTRACT

An endotracheal tube comprising a flexible hollow tube with a spiral slit traversing a substantial length of the tube. The slit has edges that separate to create an opening by which the tube may be spiral wound onto a medical device, such as a fiber optic bronchoscope, that is in use in a pharynx passage. The angle of the slit is preferably in the range of  30 - 60  degrees.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No.14/261,453, filed Apr. 25, 2014, the contents of which is incorporatedherein by reference in its entirety.

FIELD OF THE INVENTION

This invention relates to a medical instrument and the use thereof thatestablishes a “duty channel” for continuous access and control of theairway during bronchoscopy procedures.

BACKGROUND OF THE INVENTION

The fiberoptic bronchoscope is used to access the airway via entrythrough the nasopharynx or oropharynx with continued passage between thetrue vocal cords and then advancing caudally into thelaryngo-tracheo-bronchial tree. Once airway placement is achieved thefiberoptic bronchoscope facilitates the diagnostic and therapeuticcollection of glandular secretions and/or tissue specimens, foreignbodies, or tumors using the suction channel for the additional placementof flexible biopsy forceps or flexible brushes or flexible needles underdirect vision. The ease and safety with which the procedure is performedcan be modified by the presence of unexpected anatomic variations andcomplications that may arise as the bronchoscope navigates thenasopharynx in search of the laryngeal orifice housing the true vocalcords between which the fiberoptic bronchoscope will then enter thelarynx.

During the procedure a complication or finding may necessitate removaland replacement of the fiberoptic bronchoscope and continued control ofthe airway for rapid reestablishment of patency of the airway or need tobe able to mechanically ventilate the lungs while the procedure using afiberoptic bronchoscope ensues to its completion. In order to accomplishthese actions it would be necessary to place an endotracheal to able toaccept the external diameter of the fiberoptic bronchoscope.

The current state of the art would force removal of the fiberopticbronchoscope and either orotracheally intubate in the standard manner orprecharge the fiberoptic bronchoscope with an endotracheal tube over thefiberoptic bronchoscope so that after the fiberoptic bronchoscope tiphas entered the trachea one can slide the endotracheal tube over thefiberoptic bronchoscope and so control the airway and use theendotracheal tube as an access channel allowing removal and replacementof the fiberoptic bronchoscope as deemed necessary without going throughthe cumbersome process followed to initiate airway access. Some of thecomplicating factors include bleeding, encountering foreign bodies ofdifferent shapes and anatomic features such as larynx and vocal cordanomalies or polypoid tumors larger than the caliber of the suctionchannel of the fiberoptic bronchoscope.

Current options for airway management during such procedures includewithdrawal of the bronchoscope and intubation of the patient byendotracheal tube including the use of an obturator (See: U.S. Pat. No.4,960,122) as a guide. As can be appreciated, time is of the essence tomaintain airway control and prevent inadequate ventilation and/oroxygenation. Once the patient is stabilized the fiberoptic bronchoscopywould be re-started. However, any trauma that has occurred may result inchanges to more poorly identifiable access to thelaryngo-tracheo-bronchial tree arising from constriction or edema orcyanosis due to complicating hypoxemia such that insertion may bedifficult or impossible because of the presence of inadequate anatomicdefinition.

SUMMARY OF THE INVENTION

Given the inadequacies in the present state of the art, a need exists toallow placement of an endotracheal tube to allow rapid and repeatedwithdrawal and reinsertion of the fiberoptic bronchoscope. As a resultof the possibility of cumbersome anatomic variations and the importanceof time factors involved, the most expeditious manner of emergentlyplacing the endotracheal tube depends on the ability to place theendotracheal tube without being forced to remove the fiberopticbronchoscope prior to the endotracheal tube placement.

This invention is a spiral slit endotracheal tube that allows theplacement of a “duty channel” that provides continuous access andcontrol of the airway after it is spirally placed over the fiberopticbronchoscope. The spiral slit tube achieves this object without beingforced to remove the fiberoptic bronchoscope first. The practitionercould then use the “duty channel” to rapidly remove and reinsert thefiberoptic bronchoscope as deemed necessary without having to deal withany possible impediments previously described.

The duty channel, if necessary, can then be used with the help of anendotracheal tube replacement obturator for the placement of a standardcuffed endotracheal tube or rigid bronchoscope. The spiral slitendotracheal tube has the significant advantage in that allowscontinuous maintenance of access and control of the airway.

The spiral slit endotracheal tube is made of the same material alreadyused to manufacture standard endotracheal tubes. This is typically a6-8.5 mm ID plastic tube and a suitable length of about 30 cm or less.In accordance with this invention it has to have a helical slit cutthrough to the tube lumen at a continuum throughout a substantialportion of its length. The angle of the helix is determined as afunction of the wall thickness of the tube and the stiffness of thematerial to allow ready winding over the bronchoscope to be stable andsubstantially sealed once mounted. Typically, the helix angle can be inthe range of 30-60 degrees angled to the circular base to create athrough spiral slit. The edge of the slit preferably has an angledfinish so that when the slit edges are coapted it does not leave agrooved surface. When the spiral slit edges are coapted the cylindricaltube created typically has an internal diameter of 6-8 mm and a lengthof about 22-30 cm for an adult size. A device for pediatric use would besized appropriately smaller.

In operation, the spiral slit endotracheal tube is placed over thealready inserted fiberoptic bronchoscope by starting at the start of theangled slit winding the spiral slit over the shaft of the fiberopticbronchoscope until the internal wall is parallel to the axis of thefiberoptic bronchoscope. The spiral slit endotracheal tube is securedwith surgical tape to the face when the tip of the distal end of thespiral slit endotracheal tube is confirmed by the bronchoscope to be 2cm rostral to the carina. Once in place a duty channel has beenestablished. The bronchoscope may be removed and subsequentlyreinserted.

This invention will be described in greater detail by referring to theattached drawing and the description of the preferred embodiment thatfollows.

BRIEF DESCRIPTION OF THE DRAWING

FIG. 1 is a perspective view of the spiral slit endotracheal tubeaccording to this invention; and

FIG. 2 is a perspective view illustrating how the tube of FIG. 1 iswound over a bronchoscope.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring now to FIG. 1, the spiral slit endotracheal tube 10 is aflexible plastic tube made from the same material normally used tomanufacture conventional endotracheal tubes. Such devices are well knownin the art and sold by companies such as Mallinckrodt. See for example,http://www.covidien.com/rms/brands/mallinckrodt

The tube is generally made of clear plastic with an internal diameter of6-8 mm. It will be understood that this size may be varied as a functionof patient use. Thus, a device for pediatric use would be sizedappropriately smaller. Conventionally, the tube is made with aradiopaque line 12. It has a distal end 14 which is rounded, tapered orotherwise smoothed to facilitate entry. The distal end may be blunt, asillustrated, or angled. The proximal end has a connector piece 16 thatis inserted into the tube and includes a stop plate 18 which alsoprovides surfaces for securing holding the tube. The tube 10 optionallyhas a side port 22.

In accordance with this invention, the tube 10 has a spiral slit 20running from the distal end 14 to the zone near the side port 22. Theslit 20 allows the sidewall of the tube to be separated such that thetube can be “wound” on to a bronchoscope. The angle of the helix ischosen to facilitate this mounting of the tube and then close, yet notbe so loose that the tube does not remain in position. Typically theangle of the helix is in the range of 30-60 degrees. The walls of theslit may themselves be angled or tapered to allow spreading and thensecure closing after mounting over the bronchoscope.

Referring now to FIG. 2 the operation of the device according to thisinvention will be described. A bronchoscope 30 has already been insertedeither through the nasopharynx or oropharynx and the distal end 32 isadvanced caudally into the laryngo-tracheo-bronchial tree. As mentionedthis device is conventionally used for both diagnostic and therapeuticpurposes. During such procedures it is sometimes necessary to maintaincontrol of the airway without first removing the bronchoscope. Startingat the distal end 14, the endotracheal tube 10 is spiral wound over thebronchoscope 30 at a location where the clinician has access tostabilize the scope and by tactile action spread the slit over it. Oncethe distal end 14 is circumferentially mounted, the rest of the tube 10is spirally wound on and the tube 10 advances on the bronchoscope 30.When the tube 10 advances to the side port 22, mounting is complete andthe stop plate 18 is properly located. The bronchoscope 30 may be thenbe withdrawn as the airway is maintained by the tube 10.

In addition, the spiral slit endotracheal tube could provide a channelfor completing endotracheal tube placement in cumbersome situationsforcing the use of a fiberoptic bronchoscope for establishing airwayaccess. In this scenario, after winding on the spiral slit endotrachealtube over the fiberoptic bronchoscope the fiberoptic bronchoscope iswithdrawn and replaced by the endotracheal tube replacement obturatorand leaving the endotracheal tube replacement obturator within thelaryngo tracheal tree a standard orotracheal tube can be placed over theendotracheal tube replacement obturator followed by removal of theendotracheal tube replacement obturator and leaving the standardendotracheal tube in place within the orotracheal airway. Finally, theendotracheal tube is secured and the cuff of the distal portion of theendotracheal tube is inflated in the standard manner so that the distaltip of the secured endotracheal tube is 2 cm rostral to the carina.

This invention is subject to other departures and modifications withoutdeparting from the essential scope thereof. For example, while thepreferred embodiment has been described with respect to bronchoscope,the device according to this invention may be used with otherendotracheal devices. An example is use with a replacement obturator toestablish initial airway control for the subsequent placement ofinstruments and/or a tracheal tube.

Also, while the angle of the slit is preferably a helix, it is apparentthat as a function of length and the material the angle may be adjustedwithin a wide range. In an extreme case the slit itself could be 0degrees, that is, aligned with the longitudinal axis of the tube, solong as it self-seals as it is advanced around the bronchoscope.

Having described my invention, I claim:
 1. A method for spirally windingan endotracheal tube onto a medical device already in use in alaryngo-tracheo-bronchial tree, the endotracheal tube comprising aflexible hollow tube, a spiral slit traversing a substantial length ofthe tube, the slit having edges that separate to create an opening bywhich the tube may be spiral wound onto the medical device, said methodcomprising: starting at a distal end of the endotracheal tube,separating the spiral slit and placing the distal end of theendotracheal tube over the medical device at an accessible locationalong the length of the medical device; and spirally winding theendotracheal tube around the medical device and advancing theendotracheal tube along the medical device until the endotracheal tubeis fully wound over the medical device.